This case in an example where a progress scan helps to secure the diagnosis.
The diagnostic dilemma in this instance is that of miscarriage vs cervical ectopic.
According to the Australian Sonographers Association guidelines 1 which have been adopted from UK National Institute for Health and Care Excellence (NICE) early pregnancy and miscarriage diagnosis and management guidelines 2, the MSD is well below the diagnostic threshold for miscarriage on both occasions.
Although the sac appears irregular in the first scan, there is no free fluid in the endometrial cavity. No significant vascularity is demonstrated around the gestational sac either.
During the second scan, the sac is still identified in the cervix. This time however, interval growth of the MSD and yolk sac are noted. The sac is not mobile upon cervical manipulation by TVS probe which adds further weight to the diagnosis of ectopic pregnancy. Note that there is no recordable increase in Doppler activity around the gestational sac, At an early stage of an ectopic pregnancy, increased Doppler activity and the so called 'ring of fire' sign are often not present.
- urgent notification to the Obstetric team
- transfer the patient to the delivery suite
- group and crossmatch 2 units of blood
- once treated, progress beta hCG estimation
- follow up ultrasound examination may be recommended